This is my first rehab/physio type post so please read it and hopefully you will learn something from it! In this post I intend to highlight the importance of a group of muscles that I feel are often overlooked; the Gluteals.
The Gluteals are seperated into 3 main muscles.
- Gluteus Maximus: which is the largest of the three and extends the hip
- Gluteus Medius: which is abducts and internally rotates the hip
- Gluteus Minimus: which is the smallest of the three and also abducts and internally rotates the hip
Lets take a more in depth look at each muscle.
Gluteus Maximus is one of the largest muscles in the body. It originates from the external iliac crest behind the posterior gluteal line, the dorsal surface of the sacrum, lateral margin of the coccyx and the fascia of gluteus medius and the erector spinae. It travels in a caudo lateral direction and inserts on the gluteal tuberosity of the proximal posterior femur and to the Iliotibial tract. The Glute Max is a powerful extensor of the hip and also contributes to abduction. It also provides stability for the hip and knee joints during movement.
Gluteus Medius lies underneath gluteus maximus. It originates from the external surface of the ilium between the anterior and posterior gluteal lines. It inserts onto the lateral surface of the greater trochanter of the femur. Gluteus Medius abducts and internally rotates the hip and also prevents against pelvic drop during walking.
Gluteus Minimus lies underneath both Gluteus Maximus and Medius. It arises from the external surface of the ilium between the inferior and anterior gluteal lines and it inserts on the anterolateral aspect of the greater trochanter of the femur. It functions like the Gluteus Medius (hip abduction/internal rotation/prevention of pelvic drop).
The gluteal muscles are involved in everyday movement as producers and stabilisers of movement at the hip joint. They contribute to movement by firing at the correct time to produce functional efficient movement. The correct firing pattern of the Gluteus Maximus is well documented during lower limb movement. The contralateral Erector Spinae fire first, closely followed by the gluteus maximus and then the hamstring during hip extension. Consider that hip extension is a basic movement involved in all walking and running, therefore the correct function and firing pattern of the gluteus maximus is very important for everyday activity.
Gluteus Medius and Minimus are primarily stabilisers of the hip joint. They work together to provide rotational control of the leg during movement (which i will come back to later) and they also work together to produce hip abduction. Both muscles function for the same purpose and it is impossible to make one contract without contracting the other. During stance and movement these muscles prevent pelvic drop by maintaining a constant low grade contraction.
Gluteal dysfunction is very common within sport. I work with athletes and I regularly see them suffering from the same problems. Too many of our athletes dont understand how their bodies are designed to function and therefore dont know when they are actually dysfunctional. Commonly athletes suffer from three gluteal dysfunctions.
- An inability to contract the gluteals at the correct time to optimise movement
- An inability to contract the gluteals at all
- Hamstring dominance
Fortunately a skilled medical professional will easily be able to detect these problems and rectify them. Athletes who display any or all of the above conditions need re-education and proper motor learning so that the dysfunctional muscle can be taught to fire correctly as part of a chain of muscle that perform a movement or skill. Gluteal activation, Glute-hamstring dissociation and gluteal strengthening will correct these problems.
A very effective screening technique for picking up on gluteal dysfunction is the single leg squat. By observing a patient performing the single leg squat we can pick up any number of correct and incorrect joint movements. In this case it is easily visible if the patients glute med/min are working, as they control internal rotation during the movement. Consider this picture of an elite athlete, Ryan Giggs, displaying very poor rotational control (glute activation) during a single leg squat.
Bridging is another very useful screening tool for gluteal dysfunction. By observing a patient when bridging the therapist can assess the strength of gluteal contraction and whether or not the hamstrings are dominating the movement. This is done by actively palpating the glutes and hamstring during the exercise and assessing which muscles are providing the stability during the exercise. In this position it is easy for the therapist to encourage hamstring relaxation and gluteal activation by providing tactile stimulation (glute/hamstring dissociation).
The benefits of Gluteal training are plain for all to see. Happily contracting Gluteal muscles provide hip and knee stability during movement and they are important producers and controllers of forces in the human kinetic chain. Properly trained glutes will increase your running efficiency and overall strength and power in the posterior chain.
In my opinion, the gluteals are one of the most often overlooked muscles. Although in recent times i have noticed professional clubs incorporating gluteal training into their warm ups and prehab work. During a recent English Premier League fixture, the Manchester City players were seen facilitating Glute Med/Min by performing bodyweight squats with theraband tied around their knees. The importance of these muscles may be dawning on some people. Perhaps the Glutes (like Transverse Abdominus at the minute) are on the verge of becoming the next “sexy/fashionable” muscle to talk about! However in general there needs to be a conscious effort from therapists and fitness professionals to educate athletes/clients on the importance and benefits of proper gluteal function. Only through education will we have any chance of changing the current ignorance towards a very important muscle group.
Please feel free to discuss this post using the comments section below. Until next time,